URI (Common Cold)

Definition:
Upper respiratory infections (URI), also known as the common cold, are actually a group of infections caused by several different viruses. URI are usually mild, last about 1-2 weeks, and can be treated in a variety of ways. URI is the second most common reason for physician office visits. Adults have on average 2-4 episodes annually; children can have as many as 6-8 episodes per year.

URI typically affect the upper airways, which include the nose, sinuses (sinusitis), throat (pharyngitis), voice box (laryngitis), and windpipe (tracheitis or croup).

Causes:
Viruses directly cause URI. The most common viruses associated with URI include: Rhinovirus (the most common), coronavirus, respiratory syncytial virus, adenovirus, parainfluenza virus, and others. Many of these viruses can also cause lower respiratory infections, such as bronchitis and pneumonia.

Transmission of these viruses is usually by one of two ways:

1. Direct contact with secretions on skin or in the environment (e.g. Shaking hands with someone infected or touching an object (e.g. doorknob) that has been touched by someone infected)

2. Inhaling virus particles coughed out by an infected individual.

Ideally, you can avoid catching URI by washing your hands frequently, not touching your nose or eyes (this is the usual way of infecting yourself), and ask others to block their mouths when coughing or sneezing.

Symptoms:
Classic symptoms of URI are well-known to all, and include:

Additional symptoms that can occur but are less common include:

If symptoms persist beyond one week, or if symptoms fade then recur with intensity, it is worthwhile consulting a medical provider to confirm a more serious infection is not developing.

Risk Factors for URI:
Any person can develop URI. Given the widespread opportunity for sharing viruses at home, work or play, it is no wonder URI is so common. People at greater risk for URI typically either work in settings where transmission of viruses with greater ease or have medical conditions that weaken their immune system. Examples of medical conditions include:

• Any chronic disease, such as diabetes, kidney disease, lung or heart disease
• Immunosuppression (cancer, HIV, AIDS, transplant patients)
• Poor nutrition
• Poor hygiene

Additionally, any person who works at the following locales is at greater risk:

• Hospitals or medical offices
• Nursing homes
• Daycare or nursery establishments

Diagnosis:
Most people are able to recognize the above symptoms as a typical presentation for URI. Doctors see more URI in their offices thn almost any other medical condition. Key features of URI are included below:

Common Cold - Nasal stuffiness, runny nose, sneezing, mild sore throat, cough
Sinusitis - Headache, sinus tenderness, nasal congestion, cough
Pharyngitis - sore, scratchy throat, trouble swallowing, whitish covering of tonsils (exudate)
Laryngitis - Lowered voice pitch, hoarseness, loss of voice
Croup - Dry, barking cough in evening, hoarseness, shortness of breath

Another URI, which is now rare, but sometimes life-threatening is called epiglottitis. This condition causes swelling of the epiglottis, a soft-tissue area just behind and below the tongue. This condition may result in complete blockage of the airway and cause death if not rapidly identified and aggressively treated.

1. First off, antibiotics do not work for URI. Simply put, antibiotics cannot subdue viruses and are therefore potentially more harmful than helpful in treatment of URI.

2. Decongestants. There are several over the counter (OTC) decongestants available. Pseudoephedrine and phenylephrine are widely available under many brand and company names at your local pharmacy. Both of these substances dry up your nasal passages, alleviating some of the stuffy and runny nose symptoms. Be cautions about these medications if you have high blood pressure of take medications for your heart.

3. Cough suppressants. The majority of the cough medications contain the compound dextromethorphan, a common and safe medication. Some people choose to suck on hard candy, with or without any active medication, for suppressing cough. Prescription cough pills are also available and work by numbing the back of the throat and voice box, lessening the often irritating "tickle" which triggers cough.

4. Combination decongestants and cough suppressants are widely peddled for their additive effects. See above for a more detailed discussion.

5. Topical nasal sprays are of value and can shrink swollen nasal passages when applied regularly during the peak of URI. You should not use these for more than 3 days.

6. Acetaminophen is the drug of choice for sore throat or pains related to URI. Some people choose to gargle with saltwater to relieve their throat soreness.

7. Guaifenesin is a well-known mucus-thinning agent and is often recommended for URI symptoms.

8. Humidified air will moisten your nasal passages and help you feel better. Use a portable or central humidifier anytime you are in need of additional humidity.

9. Vitamin supplementation has been tried and tested for many URI symptoms, with varying results. Recent results conclude that vitamin C and zinc (in the form of lozenges) may lessen the duration of URI by about one day and may also lessen the severity of URI. There is little risk of harm in taking these supplements short term. Check with your medical provider to ensure you are a good candidate for these supplements and for the most appropriate dosing.

10. Echinacea and other herbal products have also been evaluated for their URI symptom relief. No scientific studies have confirmed herbal or other alternative remedies as more useful than known, scientifically-studied remedies. Ask your trusted health care provider for advice regarding herbal products, as needed.

11. When all else fails, remember that URI resolves on its own for the vast majority of people.

Prevention:
Simple ways to prevent URI include:

Complications:
Complications related to URI include any number of superimposed bacterial infections that lead to:

Complications are not common. If you still feel unwell after one full week and are concerned about your general well-being, of if you have more intense symptoms than usual, please consult your medical provider.

The final word:
URI is very common, especially among children. Treatment is usually comforting and supportive, but not curative. Time, rest and appropriate common sense will help ease URI passage. Please consult your family doctor for further information.

References:

1. Simasek, M; Blandino, DA. Treatment of the Common Cold. American Family Physician. 2007 (75): 515-20, 522.
2. Gurnee, MC, et.al. Upper Respiratory Infections. U.S. Pharmacist. A Jobson Publication.
3. Keen, A. Viral Respiratory Infections. Department of Medical Microbiology. University of Capetown. 1995
4. Friedlander, S; Busse, WW. The role of rhinovirus in asthma exacerbations. Journal of Allergy & Clinical Immunology. 2005. 116(2): 267-273.
5. Yale, SH; Liu, K. Echinacea purpurea Therapy for the Treatment of the Common Cold. Archives of Internal Medicine. 2004. 164(11): 1237-1241.
6. Mangione-Smith, R; Elliott, MN. Et. Al. Ruling Out the Need for Antibiotics: Are We Sending the Right Message? Archives of Pediatrics & Adolescent Medicine. 2006. 160(9): 945-952,
7. http://www.parknicollet.com/healthadvisor - accessed February 2, 2007

Copyright 2008-9, MD Kiosk, Inc